Breastfeeding documents in OLCHC Version Number 1 compilation Date of Issue Reference Number Review Interval 3 yearly Approved By Signature Date Name: Fionnuala O’ Neill Title: Chairperson Nurse Practice Committee Authorised By Signature Date Name: Geraldine Regan 18/06/13 Title: Director of Nursing Author/s Name: Elaine Harris Title: Clinical Placement Coordinator Document Review History Review Date Reviewed By Signature April 2016 Location of Copies On Hospital Intranet and locally in department Document Change History Change to Document Reason for Change CONTENTS 1.0 Breast feeding Policy Statement 3 Children’s Hospitals 2.0 Guidelines for OLCHC staff caring for mothers breastfeeding their Sick Infants 3.0 Guidelines for OLCHC staff caring for mothers expressing breast milk 4.0 Guidelines on Cup Feeding an Infant in OLCHC 5.0 Guidelines on Lactation support for a mothers who’s child has died 6.0 Lactation support information for Parents following the death of their child 7.0 Careplan 4 Breastfeeding an infant 8.0 Careplan 4a Expressing Breast milk 9.0 Guidelines for OLCHC employees wishing to continue breastfeeding on return to work 10.0 Conditions for Mothers Breastfeeding in OLCHC Breastfeeding Policy Statement The three children’s hospitals, Our Lady’s Children’s Hospital, Crumlin, (OLCHC) Children’s University Hospital, Temple St, (CUH) & National Children’s Hospital, (AMNCH) believe that breastfeeding is the healthiest way for a mother to feed her baby. It recognizes the important benefits that exist for both the mother and her child. Nursing staff of the three children’s hospitals are committed to supporting mothers who choose to breastfeed by: 1 Creating an environment that welcomes, supports and facilitates breastfeeding. 2 Giving verbal and written information of the importance and management of breastfeeding to parents of newborn babies. 3 Welcoming mothers who wish to breastfeed in any public area of the hospital and endeavouring to provide a private area for those who ask for one. 4 Arranging all interventions by hospital staff to minimise disturbance to the breastfeeding relationship. 5 Ensuring that mothers who are breastfeeding their children will have access to trained staff who have the knowledge and skills to assist mothers in establishing and maintaining breastfeeding and breast milk feeding. 6 Avoiding the use of bottles, teats and soothers whilst establishing breastfeeding, unless needed for medical reasons, or through parental choice. 7 Discussing with parents the need for fortified breast milk or alternative feeds for sick children with specific medical conditions. 8 Giving expressed breast milk or alternative feed by a feeding method conducive to the establishment of breastfeeding. 9 Supplying equipment and information for the safe expression and storage of breast milk, while in hospital. 10 Endeavouring to facilitate siblings who are being breastfed by mothers who wish to be resident with their sick child in the hospital. Where possible siblings will be facilitated to stay in the hospital. 11 Abiding by the International Code for the Marketing of Breast Milk substitutes, and WHO resolutions. 12 Informing mothers on discharge of the hospital and community breastfeeding support services and groups available to her. 13 Supporting staff working in the hospital that choose to breastfeed or express breast milk for their child. __ __ _____ ___ _______________ Director of Nursing Director of Nursing Acting Director of Children’s Nursing Services TSCUH OLCHC NCH 2nd Edition Issue date March 2013 Review date March 2015 Guidelines for OLCHC staff caring for mothers breastfeeding their sick infants in OLCHC 1st Edition 2006 Version Number nd 2 Edition, January 2013 Date of Issue Reference Number Review Interval 3 yearly Approved By Signature Date Name: Title: Chairperson Nurse Practice Committee Authorised By Signature Date Name: Title: Author/s Name: Elaine Harris Title: Clinical Placement Coordinator Location of Copies On Hospital Intranet and locally in department Document Review History Review Date Reviewed By Signature April 2016 Document Change History Change to Document Reason for Change Our Lady’s Children’s Hospital, Crumlin Document Name: Guidelines for OLCHC staff caring for mothers breastfeeding their sick infants in OLCHC Reference Number: Version Number: 2 Date of Issue: Page 2 of 31 CONTENTS Page Number 1.0 Introduction 4 2.0 Definition of breastfeeding 4 3.0 Benefits of breastfeeding/breast milk 4 4.0 Informed decision to breastfeed or not 4 5.0 Breastfeeding and Maternal Medication 5 6.0 Principles of teaching breastfeeding? 5 7.0 Breastfeeding education for nursing staff 5 8.0 Breastfeeding in public versus breastfeeding in private 6 9.0 Accommodating resident mothers to breastfeed siblings of hospitalised child. 6 10.0 International Code for the Marketing of Breast Milk Substitutes, 6 11.0 Establishing breastfeeding: 7 12.0 Milk Ejection (Let Down) Reflex 7 12.1 Milk ejection reflex responses 7 12.2 Signs of the milk ejection reflex 7 12.3 How to stimulate the Milk Ejection (Let Down) Reflex? 8 13.0 Individualised nutritional assessment 9 14.0 Recognising feeding cues 9 15.0 Positioning an infant for a breastfeed 9 15.1 Laid Back Breastfeeding 10 15.2 Bed Sharing and Breastfeeding 11 16.0 Attaching an infant 11 17.0 How to assess a good latch/attachment 12 17.1 How to assess a poor latch/attachment 13 17.2 Causes of poor attachment 15 18.0 How to assess an effective suck 15 18.1 Signs of an effective suck 15 18.2 Consequences of an ineffective suck 16 19.0 Breastfeeding patterns, frequencies and duration 16 Our Lady’s Children’s Hospital, Crumlin Document Name: Guidelines for OLCHC staff caring for mothers breastfeeding their sick infants in OLCHC Reference Number: Version Number: 2 Date of Issue: Page 3 of 31 20.0 Recognising that infants are feeds well 18 21.0 How to maintain and increase mothers breast milk supply? 19 22.0 How mothers can wean and stop breastfeeding? 19 23.0 Introducing complementary foods 20 24.0 Discharge support and Information 20 25.0 Trouble Shooting Guide 21 25.1 Mastitis 21 25.2 Blocked Ducts 22 25.3 Engorgement 22 25.4 Cracked Nipples 23 25.5 Poor supply 23 25.6 Refusal to latch/ Difficulty to latch infant on 24 25.7 Breast and Nipple Thrush 24 25.8 References 25 26.0 Appendices 30 27.0 Appendix 1: Definitions 31 27.1 Appendix 2: Conditions for Mothers Breastfeeding in Our Lady’s Children’s Hospital, Crumlin 31 Our Lady’s Children’s Hospital, Crumlin Document Name: Guidelines for OLCHC staff caring for mothers breastfeeding their sick infants in OLCHC Reference Number: Version Number: 2 Date of Issue: Page 4 of 31 1.0 Introduction Our Lady’s Children’s Hospital Crumlin (OLCHC) believes that breastfeeding is the healthiest way for a woman to feed her infant. Staff in OLCHC support mothers who choose to breastfeed according to the Breastfeeding Policy Statement (Nurse Practice Committee (NPC) 2013a). World Health Organisation (WHO) (2002) recommends exclusive breastfeeding for six months and continued breastfeeding for a minimum of two years; this is inclusive of the consumption of expressed breast milk (EBM). Nurses should enable and encourage mothers to maintain breastfeeding with the provision of timely and appropriate support (McGorrian et al 2010). Before breastfeeding mothers are discharged from maternity settings they should be able to demonstrate how to position and attach the infant to the breast and identify signs that the infant is feeding well (National Institute for Health and Care Excellence (NICE) 2008). However due to the unexpected nature of some newborn illnesses, this may become the role of the nurse in OLCHC. Therefore, these guideline aims to assist nurses to provide consistent and accurate advice and education, and to provide appropriate support and encouragement for mothers breastfeeding their sick infants in OLCHC. 2.0 Definition of breastfeeding Many definitions exist for breastfeeding with WHO’s (1996) definition leading the way by defining it as children receiving breast milk directly from the breast or indirectly via expression of breast milk (Appendix 1). World Health Organisation (WHO)(1989; 2002), FSAI (2011) and HSE (2011) also recommends that infants breastfeed exclusively until 6 months of age and complementary diet with continued breastfeeding until 2 years or older. 3.0 Benefits of breastfeeding: (this is not an exhaustive list) Breast milk is associated with long and short term health benefits and has been shown to: • Reduce the risk of developing: - GI infections - Clinical Asthma, Atopic Dermatitis, and Eczema - Respiratory Infections - Dental Caries - Otitis Media - Leukemia - Juvenile onset diabetes - Childhood Inflammatory Disease - Obesity - SIDS - Celiac Disease (when gluten is introduced while breastfeeding) • Promote brain growth and cognition • Enhance intellectual and visual development • Protect preterm infants against infection • Improve GI function and maturity • Prime the GI tract to protect against microbial invasion • Improve glucose tolerance • Stimulate the maturity of the immune system • Reduced mortality rate among preterm and low birth weight infants from necrotising enterocolitis (NEC) 4.0 Informed decision to breastfeed or not Mothers feeding decisions are guided not only by their own attitudes, beliefs and skills, but also by the perceptions of other people (Ajzen 1991). Mothers partners and family support networks influence mother’s decision to breastfeed (Kaewsarn et al 2003, Nelson and Sethi 2005) as well as health professionals. In children’s hospitals, mothers may have made their feeding decisions prior to admission, however due to the unexpected nature of their infants illness especially in the newborn period and the nature of hospitalisation mothers feeding intentions may change. Therefore nurses should make the most of this valuable opportunity to influence mothers decision to breastfeed, without applying undue force (Harris 2008). The benefits of breastfeeding should be discussed (Stuebe 2009) with parents (Hoddinott et al 2012) and the additional benefits to the sick child.